Page 49 - 2026 SMOG

UPPER RESPIRATORY DISTRESS
Signs and Symptoms Potential Causes
• Shortness of breath • Asthma
• Pursed lip breathing • Anaphylaxis/allergy
• Decreased ability to speak • Aspiration
• Tachypnea/hyperpnea • COPD
• Wheezing/rhonchi/rales • Pleural effusion
• Use of accessory muscles • Pneumonia
• Fever/cough • Congestive heart failure/cardiac
• Tachycardia • Pulmonary embolus
• Absent breath sounds • Pneumothorax
• Pericardial tamponade
• Hyperventilation
• Toxic inhalation (e.g., cyanide, CO)
ADULT PEDIATRIC
• View for obstructions (jawthrust for C-spine • View for obstructions (jawthrust for C-spine
injury), sweep, and suction prn injury), sweep, and suction prn
• Monitor O and EtCO 2 • Monitor O and EtCO 2
2
2
• Place on 100% oxygen via NRB • Place on 100% oxygen via NRB
• Administer Albuterol 90mcg/actuation MDI, • Administer Nebulized Racemic Epinephrine
2–3 actuations prn or 2.5–5mg nebulized 0.25–0.5mL of 2.25% solution diluted in
• Monitor for allergic reactions: 3mL NS
˚ Consider Epinephrine 1mg/mL 0.3mg IM • Monitor for allergic reactions
Consider Epinephrine
(EpiPen)
• Initiate IV/IO access ˚ ˚ 15–30kg: 0.15mg IM (EpiPen JR)
• Administer Methylprednisolone 125mg IV ˚ >30kg: 0.3mg IM (EpiPen)
OR
˚ Epinephrine 1mg/mL, 0.01mg/kg IM
(max 0.3mg)
• Administer Methylprednisolone 2mg/kg IV
(See drug card for maintenance dose)
Notes, Cautions, Warnings
• SpO <90% or respiratory status continues to deteriorate, consider definitive airway control.
2
• Albuterol can be administered with a spacer or a short (6") section of ventilator tubing to
increase delivery if the patient is unable to perform the action appropriately.
• Lack of abnormal breath sounds does not always signify improvement. As respiratory status
worsens, there may be inadequate air movement to produce these sounds.

2026 Standard Medical Operating Guidelines (SMOG) • 41